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Final Report: Cameroon Childspacing Promotion Project, JHU/PCS, 1995

Introduction

June 30, 1994 marked the conclusion of the three-phase Cameroon Child Spacing Promotion Project, conducted by the Ministry of Health, Directorate of Family and Mental Health, Health Education Service with assistance from the Johns Hopkins University/Population Communication Services. This project was part of the National Family Health Project (USAID bilateral project). Under the bilateral, family planning services were integrated into the primary health care (PHC) delivery system. They were also expanded to the private sector through a social marketing program and family planning clinics operated by missionary and private commercial sectors. The Cameroon Child Spacing Promotion Project provided print, audio-visual and counseling materials to all public and private sector family planning service delivery activities under the bilateral, except the social marketing program. These materials complemented the service delivery and training components of the National Family Health Project.

Background and Baseline Findings

Awareness of family planning

Cameroon, until the late 1980's was one of the last official pronatalist countries in Africa. Much of the population remained unaware of modern contraceptives until the early 1990's while those who were aware possessed incomplete and inaccurate information, A knowledge, attitudes and practices (KAP) study conducted in the North Province in 1989 showed that under 30% of those surveyed were aware of family planning, only slightly higher than the 28% recorded in the national 1978 Cameroon Fertility Survey. As this project’s baseline survey indicates, by 1991, awareness among the urban respondents was above 85%. Both the baseline study and a 1990 focus group in Yaounde, however, revealed that rumors and misinformation were widespread.

Attitudes towards family planning

Cameroonians who are aware of contraception have overwhelmingly favorable attitudes toward family planning. The 1978 Cameroon Fertility Survey and a 1990 Save the Children study indicated that about 80% of the "aware population" favored contraception. The 1991 baseline survey indicated that more than 50% of those who had never used contraception reported their main reason for not using contraception was fear or lack of information, both reasons requiring an IEC solution.

Government policy

The government of Cameroon has taken significant steps in the last few years toward making family planning services and information more readily accessible. First, it established legislation to support maternal/child health and family planning; then it created a Directorate of Family and Mental Health (DFMH) within the Ministry of Public Health (MOPH). The DFMH worked with other organizations in Cameroon to promote the role of IEC in the evolving family planning program. The DFMH conducted a conference to define policies and strategies which was sponsored by UNFPA and SEATS, and, in 1990, an IEC consensus-building seminar was organized, with JHU/PCS assistance; these activities resulted in an overall family planning strategy and designated the MOPH/DFMH as the main coordinating body of family planning.

IEC

All IEC activities were developed based on the national strategy and the results of research carried out since 1990. One of the primary objectives was to increase the number of new and continuing contraceptive users. This was done by providing adequate and correct method-specific information, reinforcing the positive attitudes and images of family planning users, and encouraging intra-couple communication about family planning. IEC activities expanded to keep pace with the expansion of service delivery sites with trained providers. Thus, by the final phase, there were activities in all ten provinces.

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The Changing Image of Contraceptives in Cameroon: Impact of a Multi Media Campaign, Jato.M, et al, JHU/PCS, 1994

Introduction

In 1991 a survey conducted in Cameroon highlighted negative images of contraceptive methods, users, service providers, and images of social disapproval of modern contraceptive methods. As a result, a multi-media campaign was designed and implemented in five urban towns: Yaounde, Duala, Bafoussam, Bamenda and Buea for a period of two years to address some of the image problems. The campaign included the training of service providers, the development and launching of a national family planning logo, and the production and dissemination of family planning IEC materials. As a result of the campaign, images of methods, users, provider and social approval improved.

Findings

Results of formative research

Negative images of modern contraceptive methods present potential or actual barriers to their adoption and continuing use. For example, 29% of men and women contraceptive never users and 51% of non-current users in an audience survey of five towns in Cameroon indicated that they were not using modern methods because they feared side effects of the methods. In addition, respondents were asked to indicate information they frequently have heard about modern contraceptives. The most frequently mentioned information they had heard included: convenience, potential for causing sterility, effectiveness and safety of modern methods.

Oral contraceptives

Oral contraceptives are the most readily available and the most frequently used family planning method in Cameroon. Weight gain (32%), sterility (21%), health problems(17%), ineffectiveness (7%), multiple births (13%), and promote promiscuity(12%) were some of the negative images associated with oral contraceptives.

Intra-Uterine Devices

Since Cameroonians are generally unfamiliar with IUDs, their image of these contraceptive methods could have been effected by their lack of knowledge and/or experience with the method. Negative information most frequently cited about IUDs were that they could cause uterine damage (15%), bleeding (15%), sterility (9%), and that they caused other problems such as abdominal pain, headaches and fever

Condoms

With the design and implementation of an aggressive campaign for the prevention of AIDS in Cameroon, more Cameroonians had heard of and used condoms. Their images, therefore, could have been affected by their personal experiences with condoms or by the experiences of people they knew. Negative images of condoms included: reduce sexual pleasure (47%), lengthen sexual intercourse time (22%), were inconvenient (18%), were ineffective (12%).

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Role of Male Opinion Leaders in the Promotion and Delivery of Family Planning Services in Cameroon, Sanogo,D., Awasum,D, Paper prepared for the American Public Health Conference, 1992

Introduction

Family Planning national policy was adopted in 1989 and marked the creation of the Cameroon National Association for Family Welfare (CAMNFAW) which is the IPPF affiliate and the Directorate of Family and Mental Health (DFMF) within the Ministry of Health. The DFMH was created by a presidential decree and has in its mandate the promotion and coordination of FP activities in the country.

Although Family Planning was becoming important in Cameroon, the government did not feel that the time was appropriate to start providing services all over the country, the approach was to first focus on IEC activities. If IEC generated demand, then thought could be given to the provision of services. At the time this article was written (1992), FP services were offered in hospitals and in health centers at the district level. As a result of the relatively limited availability of services, awareness of family planning was low, particularly outside the urban centers of Younde and Douala.

Description of Project

A project implemented by the MOH gave the government opportunity of provide FP services in rural areas without going through the difficult steps of first formulating national policy. This project harnessed the influence and motivation of "male opinion leaders". It was hoped that they could be brought to play a leading role in promoting maternal/child health and FP in their communities. In many rural areas, traditional chiefs (called fons in the northwest region) exert a strong influence on community norms and behaviors. In addition, men generally have a conservative attitude towards issues such as FP. It is strongly felt that unless men can be persuaded to take a positive and active interest in maternal/child health, family planning will make few inroads in the area.

The project was implemented in the district of Nkambe in the Donga Mantung. The male opinion leaders were trained to carry out IEC activities; sell condoms, spermicides and ORS; make referrals to health centers for other FP services.

This project had not been completed at the time of the report. However, the initial impact indicated that the project brought FP services to rural areas; the training of health personnel would increase the quality of health and FP service delivery; increased the interest of the government in exploring the decision to expand services to other rural areas using a CBD model; additional Operations Research studies have been requested by the government and USAID.

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Cameroonian Nurses’ Perceptions of Family Planning: Implications for Nursing Practice, Jato,M. et al, JHU/PCS 1992

Introduction

This 1992 study of 67 service providers indicated that one-half of service providers had received training in family planning. This was a reflection of an increase in emphasis of the medical and nursing schools on the training of doctors, nurses and midwives in family planning. FP courses were first introduced in the medical nursing and midwifery training in 1989. Prior to this, FP trainers and providers received training in FP from international and national workshops. Training and updating of trainers and providers’ knowledge and skills in various aspects of FP services has gained tremendous momentum recently (1992).

Findings

IEC

Regarding IEC materials, most service providers endeavored us use the limited supply of audio-visual materials to counsel clients on FP. During the six months preceding the study, 61% had counseled FP clients using audio-visual materials - posters and method samples were most frequently used. Service providers refrained from distributing FP pamphlets because they were scarce.

Attitudes and methods recommended

Eighty-eight percent of providers said modern methods should be available to all Cameroonians. Eleven percent said family planning is a foreign plot to the reduce the African population. Most of the providers (84%) said it was their job to choose the method that was best for their clients which constitutes a barrier to adoption and continuation of a method. Most recommended the pill (69%) or injectables (25%). IUDs and condoms were perceived as the least effective methods. In addition, providers perceive the IUD and injectables as the most harmful methods. Cameroonians single out the IUD as the most harmful method. Most Cameroonian service providers have not been trained in IUD insertion which may influence perception of the IUD as harmful.

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Awing’s Maternal and Child Health Care: An Inquiry of Infant Weaning Practices and the Knowledge, Attitudes and Practices of Contraception, Smith, J., 1992

Introduction

The following are the results of a 2 ½ month research stay in Awing, a rural village in the North Western region of Cameroon in 1992. Although the policy information is dated, it represents a rich qualitative resource of a wide spectrum of health practices in one Cameroonian village. Individual household questionnaires were administered to 218 women and 178 men.

Findings

Reasons for spacing

Women said that the ideal spacing of births is approximately 31 months. They claim to want to space their births for the health /strength of the child (27%), to prevent Kwashiorkor/to have enough to feed children (22%), the woman wants to rest/children are hard work (11%), so that the older child may take care of the new child (9%) or the woman has been personally ill while pregnant (8%). Ninety-nine percent of the women approve of birth spacing. Nchitmone is the Awing word used to ridicule or disapprove of a woman who has become pregnant too quickly.

Spousal decision-making and communication

According to the women, the wife holds the most responsibility for determining family size (40%), followed by the wife and husband together (27%), and then the husband primarily (21%). Approximately 83% of the women said they have discussed birth spacing with their husbands at least once and 39% claim to have had more than two discussions.

Age at first birth and desired number of children

The average age of first birth for an Awing woman is 18+/-3 years. The average age of the first sexual relationship is 16+/-3 years. A notable number of adolescents who delivered their first child said they would have preferred to have waited but did not think that they would get pregnant. Women believed that women should have approximately 8 children. Twenty-six percent of women in reproductive ages and 9% of men said they did not want more children. Men, in general, desire more children than women.

Rumours

Rumors concerning modern contraceptive methods are based on the secondary effects of the method. In the study community, men were generally inclined to point out dangers of modern methods, but women too expressed their fear of the possible damage to the reproductive system. In particular, people held a belief that condoms can break and go into a woman’s belly and destroy the womb. Regarding tradition methods, some men thought withdrawal could be harmful to the normal physiology of the man while use of the rhythm method with periodic abstinence relied largely upon erroneous knowledge of a woman’s menstrual cycle.

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